目的:低价值成像与浪费的医疗保健支出和患者伤害有关。常规使用磁共振成像(MRI)进行外上髁炎的检查是低值成像的一个例子。因此,我们的目的是调查订购的MRI用于外上髁炎,那些接受核磁共振的人的特征,以及MRI与其他护理的下游关联。
方法:我们使用Humana索赔数据库确定了2010年至2019年间诊断为外上髁炎的年龄≥18岁的患者。我们确定了与肘部MRI相对应的当前程序术语代码的患者。我们分析了接受MRI的患者的使用和下游治疗级联。多变量逻辑回归模型用于评估接受MRI检查的几率,调整年龄,性别,保险类型,和合并症指数。使用单独的多变量逻辑回归分析来确定接受MRI与次要结局发生率之间的关联(例如,接受手术)。
结果:总共624,102例患者符合纳入标准。在接受MRI检查的8209例(1.3%)患者中,3,584(44%)在诊断后90天内接受了它。MRI使用存在明显的区域差异。MRI是由初级保健专科和年轻人订购的最常见的,女性,商业保险,和有更多合并症的患者。MRI的表现与下游治疗的增加有关,包括手术(赔率比[OR],9.58[9.12-10.07]),注射(或,2.90[2.77-3.04]),治疗(或,1.81[1.72-1.91]),和费用(每位患者134美元)。
结论:尽管MRI对外上髁炎的使用存在差异,但其使用与下游效应相关,MRI用于诊断外上髁炎的常规应用较少。
结论:MRI用于外上髁炎的常规应用较低。了解干预措施以最大程度地减少外上髁炎的低价值护理可用于指导改善工作,以最大程度地减少其他疾病的低价值护理。
OBJECTIVE: Low-value imaging is associated with wasteful health care spending and patient harm. The routine use of magnetic resonance imaging (MRI) for the work-up of lateral epicondylitis is an example of low-value imaging. As such, our aim was to investigate the use of MRIs ordered for lateral epicondylitis, the characteristics of those undergoing an MRI, and the downstream associations of MRI with other care.
METHODS: We identified patients aged ≥18 years with a diagnosis of lateral epicondylitis between 2010 and 2019 using a Humana claims database. We identified patients with a Current Procedural Terminology code corresponding to an elbow MRI. We analyzed the use and downstream treatment cascades in those undergoing MRI. Multivariable logistic regression models were used to assess the odds of undergoing an MRI, adjusting for age, sex, insurance type, and comorbidity index. Separate multivariable logistic regression analyses were used to determine the association between undergoing an MRI and the incidence of secondary outcomes (eg, receiving surgery).
RESULTS: A total of 624,102 patients met the inclusion criteria. Of 8,209 (1.3%) patients undergoing MRI, 3,584 (44%) underwent it within 90 days after diagnosis. There was notable regional variation in MRI use. The MRIs were ordered most frequently by primary care specialties and for younger, female, commercially insured, and patients with more comorbidities. Performance of an MRI was associated with an increase in downstream treatments, including surgery (odds ratio [OR], 9.58 [9.12-10.07]), injection (OR, 2.90 [2.77-3.04]), therapy (OR, 1.81 [1.72-1.91]), and cost ($134 per patient).
CONCLUSIONS: Although there is variation in the use of MRI for lateral epicondylitis and its use is associated with downstream effects, the routine use of MRI for the diagnosis of lateral epicondylitis is low.
CONCLUSIONS: The routine use of MRI for lateral epicondylitis is low. Understanding interventions to minimize such low-value care in lateral epicondylitis can be used to inform improvement efforts to minimize low-value care for other conditions.